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http://www.archive.org/details/conservingvisionOOmcmuiala 


==BuiXETIN  oFtho= 

American  Axjociation 

/ort/ie 

CoN5EI»ATION  ofNlSYM 

Vo/.i  mi 

DOUGLAS  C.  McMURTRIE,  General  Editor. 


Conserving  Vision 


Compiled  by  Douglas  C.  McMurtrie.      Edited  by 

[  G.  E.  de  Schweinitz,  M.D.,  F.  Park  Lewis,  M.D., 

Louis  Bell,  Ph.D.,    and   E.  Leavenworth    Elliott. 


American  Association  /orfAe  CoNSEavATioNo/*VisiON 
25  West  5Q  ~  Street       •     .     .      New    York    Citv 


Donglas  C.  McMurtrie 
New  York  City 


Copyright,  1911,  by  the 

American  Association 

for  the  Conservation  of  Vision 


WW 
11-3 

Conserving  Vision 

The  eye  is  one  of  the  most  useful  and  indispensable 
organs  of  the  body.  Through  the  function  of  vision 
practically  all  knowledge  is  acquired  and  by  aid  of  the 
eye  almost  all  work  and  activity  is  directed. 

Yet  the  eye  has  been  the  victim  of  serious  abuse 
and  neglect,  and  the  mistreatment  is  reflected  in  present 
conditions,  which  are  little  realized  and  have  been  given 
but  slight  attention.  In  the  United  States  there  are 
estimated  to  be  100,000  persons  totally  or  practically 
blind.  And  most  of  this  blindness  is  preventable.  But 
there  is  another  situation  of  far  more  gravity. 

At  least  half  of  the  educated  class  in  the  United 
States  are  afflicted  with  serious  defects  of  vision.  The 
truth  of  this  statement  is  easily  seen  by  thinking  of  the 
number  of  people  who  are  absolutely  dependent  upon 
spectacles  or  eyeglasses.  Even  with  these  artificial  aids 
there  are  thousands  of  people  who  are  chronic  victims 
of  eye-strain.  In  addition  to  the  physical  discomfort 
such  people  suffer,  the  loss  in  efficiency  is  tremendous. 
They  are  only  able  to  use  their  eyes  for  part  of  the  day 
and  they  are  absolutely  prevented  from  doing  any  con- 
tinuous work.  In  addition  it  is  a  well  known  fact  that 
eye  trouble  is  the  cause  of  many  other  physical  ills. 
Many  chronic  maladies,  such  as  headache,  indigestion 
and  nervousness,  are  direct  resultants  of  eye-strain. 

The  economic  loss  engendered  by  eye-strain  is  thus 
seen  to  be  of  vast  importance.  In  the  present  age,  with 
the  great  increase  of  printed  matter  and  the  consequent 
increase  in  close  eye-work,  the  importance  to  the  people 
of  good  eyes,  capable  of  doing  efficient  work,  is  tremen- 
dously enhanced.  But  instead  of  being  a  people  with 
good  eyesight,  the  contrary  is  conspicuously  the  case. 

The  situation  is  one  which  has  received  almost  no 
attention  at  all,  yet  eye-strain  and  defective  vision  can 


4  Bulletin  of  the  American  Association 

also  be  practically  entirely  prevented.  The  conspicu- 
ous reason  for  the  present  conditions  is  the  practicalh' 
universal  ignorance  regarding  the  eyes,  their  care,  and 
the  way  in  which  they  should  be  used.  Perhaps  because 
eye-strain  and  defective  vision  do  not  have  fatal  results 
is  the  reason  the  importance  of  the  situation  has  not 
been  brought  to  us  before  with  more  emphasis. 

With  the  realization  of  present  conditions,  how- 
ever, there  is  presented  a  hopeful  aspect  in  the  fact  that 
a  very  large  proportion  of  eyesight  defects  and  losses 
can  be  prevented.  And  this  is  essentially  fundamental 
work.  While  it  is  desirable  and  necessary  to  care  for 
present  cases  of  lost  and  impaired  vision,  real  progress 
will  be  made  only  by  preventive  work — by  shutting  up 
the  sources  whence  the  trouble  has  come.  So,  while  rem- 
edying poor  eyesight  to  the  best  of  our  ability,  the  most 
permanent  results  will  be  attained  by  saving  the  eyesight 
we  have  from  further  harm. 

The  conservation  of  vision  is  of  vast  importance  in 
every  respect.  From  the  standpoint  of  economics,  soci- 
ology and  personal  happiness,  good  eyesight  is  essential. 
It  will,  therefore,  be  thoroughly  worth  while  to  consider 
the  agencies  detrimental  to  the  eyes  together  with  the 
respective  preventive  measures  best  calculated  to  coun- 
teract or  avoid  them. 

At  the  present  time  most  people  are  using  their 
eyes  under  the  worst  possible  conditions  rather  than 
under  the  best.  This  situation  could  easily  be  reversed 
were  people  given  any  instruction  in  the  care  of  their 
vision. 

How,  then,  are  the  e5^es  injured  and  what  are  the 
best  methods  of  care? 

Detriments  to  Eyesight. 

Loss  or  impairment  of  vision  results  from  strain 
due  to  overwork,  from  using  the  eyes  in  ways  calculated 
to  strain  them,  or  imder  improper  conditions  of  illumina- 


for  the  Conservation  of  Vision 


tion,  from  uncorrected  defects  in  the  physiological 
structure  of  the  eye,  from  accidents  to  the  eye,  and  from 
eye  diseases. 

Overwork  of  the  Eyes. 

Most  people  very  often  overwork  their  eyes.  They 
work  continuously  on  fine  matter,  when  their  eyes  are 
in  no  condition  to  perform  their  duty,  especially  in  cases 
where  eyesight  is  alreadj^  defective;  such  a  policy  is 
suicidal.  The  length  of  application  should  be  regulated 
to  the  strength  of  the  eyesight  and  the  eyes  should  be 
rested  occasionally,  either  by  closing  them  for  a  few 
minutes  or  by  looking  at  some  distant  object. 

Children  are  especially  liable  to  overwork  of  the 
eyes,  and  the  schools  are  persistent  offenders  in  this  re- 
gard. The  muscular  weakness  of  children  is  so  apparent 
that  ample  allowance  is  made  in  the  tasks  the  muscles  of 
the  body  are  assigned  to  perform ;  but  that  the  eyes  are 
equally  incapable  of  performing  the  work  which  would 
be  expected  of  a  mature  person  is  far  too  frequently 
disregarded.  The  fact  that  a  child's  vision  is  appar- 
ently even  more  distinct  than  that  of  an  older  person  is 
due  to  the  flexibility  of  the  lens  of  an  immature  eye, 
and  only  adds  to  the  popular  misconception.  That  the 
vision  of  children  is  more  easily  fatigued  to  the  point 
of  injurj^  by  continuous  application  to  near  objects, 
there  is  not  the  slightest  doubt. 

Conditions  which  Strain  the  Eyes. 

It  would  seem  that  matter  expressly  intended  for 
interpretation  through  the  eye  should  be  prepared  with 
some  regard  for  the  welfare  of  that  organ.  This  ap- 
pears, however,  to  be  seldom  the  case.  Printed  mat- 
ter, which  is  the  most  frequent  object  of  eye-work,  is 
a  persistent  offender  against  vision.  Whereas  the  type 
should  be  large,  the  margins  ample,  the  spacing  clear, 
and  the  paper  of  a  dull  finish  so  as  not  to  reflect  the 
light,  the  direct  contrary  is  often  the  case.     Books  and 


6  Bulletin  of  the  American  Association 

magazines  are  far  too  frequently  printed  on  shiny  paper 
and  the  newspapers  offend  not  only  in  the  size  of  their 
type,  but  also  in  the  clarity  of  their  impression. 

As  type  figures  so  largely  in  the  work  of  the  eye, 
its  character  is  of  great  importance.  In  general  it  may 
be  said  that  it  should  be  of  generous  size,  plain  in  style, 
and  free  from  "hair-lines"  and  fancy  addenda. 

All  work  with  the  eyes  should  be  done,  so  far  as 
possible,  with  the  matter  more  nearly  perpendicular  to 
the  line  of  vision.  That  is,  school  desks  and  other  read- 
ing supports  should  be  tilted  at  an  angle  of  about  thirty 
degrees.  It  is  hardly  necessary  to  point  out  that  this 
fact  has  been  almost  universally  disregarded  in  the 
schools,  where  the  great  majority  of  close  study  is  done. 

As  the  eye  is  part  of,  and  dependent  upon,  the 
physiological  structure,  it  is  important  that  general  con- 
ditions be  as  hygienic  as  possible. 

Reading  in  moving  trains  or  other  conveyances  is 
injurious  because  the  relative  positions  of  the  eye  and 
the  matter  being  read  are  constantly  shifting. 


for  the  Conservation  of  Vision 


Illumination 

One  of  the  most  prevalent  sources  of  injury  to  the 
eye  is  improper  illumination.  The  prevalence  of  bad 
illumination  is  as  general  as  defective  eyesight,  and  both 
are  well-nigh  universal.  Furthermore,  the  effects  of 
eye-strain  caused  by  bad  illumination  may  produce 
defects  in  vision,  besides  aggravating  those  already 
existing. 

To  have  the  eyes  properly  tested  and  fitted  with 
glasses  involves  more  or  less  expense,  and  hence  affords 
some  excuse  for  the  neglect  of  this  prolific  cause  of 
bodily  ills  and  discomfort ;  but  this  does  not  hold  in  the 
case  of  bad  illumination,  for  good  illumination  costs  no 
more,  and  in  the  majority  of  cases  considerably  less. 
The  use  of  bad  illumination  can  therefore  be  charged 
to  nothing  but  want  of  knowledge  of  the  subject.  But 
for  such  ignorance  there  are  some  extenuating  circum- 
stances. The  subject  is  one  which  has  only  recently 
been  given  careful  scientific  attention,  and  the  knowl- 
edge of  what  is  good  and  bad  illumination,  and  of  how 
to  obtain  that  which  is  good,  has  been  by  no  means  gen- 
erally disseminated.  The  subject,  however,  is  neither 
difficult  nor  complicated,  and  the  observance  of  a  few 
plain  rules  will  obviate  at  least  the  more  serious  faults. 


Daylight  Illumination. 

Daylight  has  always  been  accepted  as  the  standard 
of  perfect  illumination,  and  this  is  true  for  all  general 
purposes,  although  there  are  some  exceptional  cases  in 
which  artificial  light  is  superior.  Direct  sunlight  should 
never  be  used  for  any  kind  of  close  eye-work,  and  win- 
dows which  receive  direct  sunlight  should  be  equipped 
with  light  buff  or  green  Holland  shades. 


8  Bulletin  of  the  American  Association 

Ceilings  should  be  kept  white,  and  side  walls  either 
white,  light  buff  or  light  olive  green,  according  to  condi- 
tions, if  efficient  artificial  lighting  is  desired.  Dark 
tints  greatly  increase  the  amount  of  light  required  for 
adequate  illumination.  White  should  be  used  where  the 
supply  of  daylight  is  limited,  as  in  the  case  of  many 
factories  and  workshops,  especially  in  the  larger  cities; 
light  buff  or  cream  color  is  preferable  where  there  is  an 
abundance  of  north  light  and  a  considerable  amount  of 
blank  wall;  while  green  or  deep  buff  is  preferable  for 
rooms  with  large  window  space  receiving  direct  sunlight. 

The  daylight  illumination  of  rooms  having  win- 
dows only  on  one  side  or  end  can  be  greatly  improved 
by  the  use  of  prismatic  glass  in  the  upper  half  of  the 
window.  By  this  means  it  is  possible  to  illuminate  a 
room  having  a  length  at  least  twice  its  width,  with  win- 
dows at  one  end  only,  with  practical  uniformity. 

Flat  skylights  are  to  be  avoided  as  they  give  the 
same  effect  as  working  under  the  open  sky.  The  most 
satisfactory  of  all  methods  of  daylight  illumination  is 
the  so-called  "saw-tooth  construction" ;  but  this  of  course 
is  only  available  in  one-story  structures.  The  eyes 
should  never  be  obliged  to  face  a  window  having  the 
open  sky  in  view  unless  window  shades  are  provided  to 
cut  down  the  light  if  it  becomes  too  strong.  This  pre- 
caution should  be  observed  in  the  placing  of  machinery 
and  benches  in  factories. 


A rtificial  Illumination. 

The  first  thing  is  to  discharge  the  mind  of  all  pre- 
conceived notions  as  to  this  or  that  light  being  "hard  on 
the  eyes."  All  light  soiu'ces  in  common  use  are  capa- 
ble of  giving  an  illumination  that  is  perfectly  agreeable 
to  the  eyes;  it  is  the  way  in  which  the  lights  are  used 
that  makes  them  hard  on  the  vision.  Thus,  with  the 
proper  equipment  it  would  be  impossible  to  tell  whether 


for  the  Conservation  of  Vision 


a  room  were  lighted  with  oil  lamps,  gas  or  electricity. 
]Many  people  still  use  oil  lamps  with  the  idea  that  their 
light  is  easier  on  the  eyes,  the  notion  still  being  common 
that  electric  light  is  hard  on  the  ej^es.  The  light  of 
kerosene  lamps  is  easj^  on  the  eyes  because  such  lamps 
are  always  placed  on  tables,  and  nearly  always  covered 
with  shades  which  completelj''  hide  the  flame;  and  even 
if  the  flame  is  seen,  it  is  so  much  less  bright  than  the 
electric  light  that  it  is  comparatively  harmless.  But 
use  an  electric  lamp  in  the  same  w^ay  that  an  oil  lamp  is 
used,  that  is,  supply  it  with  the  proper  shade  to  protect 
the  eyes  and  diffuse  the  light,  and  the  illumination  pro- 
duced is  not  only  just  as  easy  on  the  eyes,  but  cannot 
be  distinguished  from  that  of  an  oil  lamp. 

The  same  conditions  apply  to  gas.  Thus,  the  gen- 
eral notion  in  regard  to  gas  is  taken  from  the  old-fash- 
ioned flame  jet,  which  flickers  and  blows  and  gives  a 
wavering,  unsatisfactorj'-  illumination.  The  modern 
mantle  burner,  however,  when  fitted  with  the  proper 
shade,  gives  an  illumination  which  is  absolutely  steady 
and  of  a  quality  which  cannot  be  distinguished  from  the 
best  electric  or  oil  light. 

If  gas  is  used  for  illumination  the  flame  burner 
should  be  entirely  discarded  except  in  the  few  places 
where  a  light  is  seldom  required.  Good  mantle  burners 
consume  but  half  the  gas  of  an  ordinary  jet  and  give 
from  four  to  six  times  the  amount  of  light.  The  mantle 
burner,  however,  is  entirely  too  brilliant  to  be  used 
without  a  shade  or  diffusing  globe.  The  test  for  the 
proper  equipment  of  either  a  gas  or  electric  lamp  is  to 
look  at  it  from  every  position  in  which  j'^ou  would  be 
likely  to  sit  or  stand,  and  see  if  any  part  of  the  mantle 
or  filament  is  in  sight ;  if  so,  it  should  be  covered  in  some 
way. 

Globes  and  Shades. 

The  various  devices  for  use  in  connection  with 
lamps  may  be  roughlj^  divided  into  globes  and  shades. 


10  Bulletin  of  the  American  Association 

The  former  include  those  which  the  light  passes  through, 
and  the  latter,  those  which  are  intended  to  reflect  the 
light. 

The  purpose  of  globes  is  to  diffuse  and  soften  the 
light,  and  thus  prevent  glare.  A  globe  should  entirely 
hide  the  luminous  surface  and  should  show  no  brilliant 
spots  of  light.  Those  made  of  some  form  of  white 
glass  most  completely  diffuse  the  light  and  are,  there- 
fore, most  agreeable  to  the  eyes.  Globes  of  a  light  yel- 
low or  green  tint  still  further  soften  the  light. 

Shades  of  translucent  material  are  generally  prefer- 
able, those  of  white  porcelain  coated  with  translucent 
green  being  very  satisfactory,  as  are  also  those  of  heavy 
white  glass.  Prismatic  glass  shades  should  either  be  of 
the  satin-finished  type  or  should  be  covered  on  the  out- 
side with  thin  silk.  When  an  open  shade  is  used  with 
an  electric  lamp  the  lower  portion  of  the  bulb  should  be 
frosted,  and  when  used  with  a  mantle  burner  an  eye-cup, 
or  "bobesche,"  should  be  used.  Bare  gas  or  electric 
lamps  should  never  be  tolerated. 

Lighting  Fixtures. 

Wall  brackets  are  generally  a  poor  method  of 
lighting  a  room;  they  produce  cross  lights,  and  shine 
more  or  less  directly  into  the  eyes.  They  are  admissi- 
ble for  general  illumination  in  rooms  where  no  reading 
or  close  eye-work  is  to  be  done,  provided  they  are  well 
shaded  or  screened.  A  single  bracket  can  be  made  to 
give  an  excellent  reading  light  by  using  a  good  reflec- 
tor, and  sitting  with  the  back  to  the  light.  A  single 
tungsten  lamp  or  mantle  burner  will  thus  give  a  light 
for  several  people. 

The  central  chandelier  is  often  no  more  satisfactory 
than  brackets.  It  is  very  common  to  find  such  chande- 
liers supplied  with  gas  jets  in  the  form  of  Jhiitation  can- 
dles, the  flame  consequently  having  no  globe  or  shade, 
and  electric  lamps  in  a  vertical  position,  sometimes  with 


for  the  Conservation  of  Vision  11 

no  shade  at  all,  and  frequently  with  some  fancy  shade  or 
globe  which  shows  bright  spots  of  light  and  cuts  off  the 
rays  underneath  where  one  would  naturally  sit  to  read 
or  work.  In  other  cases  the  electric  lamps  are  turned 
out  at  an  angle  and  fitted  with  open  globes  which  expose 
the  bare  filament  of  the  lamp.  In  any  of  these  cases 
the  resulting  illumination  is  exceedingly  hard  on  the 
eyes.  Diffusing  globes  or  shades  entirely  concealing 
the  filament  should  always  be  used  for  chandeliers. 

Where  the  ceiling  is  white,  as  is  now  generally  the 
case,  an  exceedingly  restful  effect  can  be  obtained  by 
indirect  lighting.  This  is  accomplished  by  using  an 
opaque  reflector  which  will  throw  the  light  on  the  ceil- 
ing, from  which  it  is  diffused  throughout  the  room. 
This  can  be  very  easily  accomplished  on  chandeliers  in 
which  the  electric  lamps  are  in  an  upright  position  by 
simply  using  such  reflectors  in  the  space  of  the  ordinary 
globes.  Small  mantle  gas  burners  which  take  the  same 
size  shade-holder  as  an  electric  lamp  can  be  obtained, 
and  by  using  these  in  the  place  of  the  ordinary  gas  jet 
the  same  method  can  be  carried  out  with  gas.  Fix- 
tures especially  designed  for  indirect  lighting  can  be 
had  in  many  beautiful  patterns. 

The  fixture  known  as  the  "dome,"  when  properly 
used,  gives  an  excellent  light  for  reading  or  for  the 
dining  room.  The  height  of  the  fixture  and  position 
of  the  lamp  should  be  such  that  the  light  source  cannot 
be  seen.  Electric  lamps  should  be  frosted  to  prevent 
streaks  of  light,  unless  enclosed  in  thoroughly  diffusing 
shades.  If  gas  is  used  a  single  inverted  mantle  burner 
thoroughly  screened  is  advisable. 


Light  Sources. 

Within  the  past  few  years  a  new  type  of  electric 
lamp  having  a  metal  filament  has  come  into  use.  These 
lamps  are  more  economical  than  the  old  types,  giving 


12  Bulletin  of  the  Ainerican  Association 

two  or  three  times  the  amount  of  light  for  the  same 
amount  of  electric  current.  They  are  also  far  more  bril- 
liant, and  consequently  even  greater  care  should  be 
taken  in  diffusing  their  light. 

The  latest  form  of  mantle  gas  burner  is  known  as 
the  "inverted,"  since  the  mantle  is  suspended  below  the 
flame.  Such  lamps  are  the  most  economical  of  all  in 
the  use  of  gas,  and  require  the  least  frequent  renewing 
of  the  mantles.  The  light  is  very  brilliant,  however, 
and  should  always  be  covered  with  a  good  diffusing 
globe. 

General  Directions. 

In  reading  or  writing  the  light  should  never  come 
from  squarely  in  front,  since  this  will  produce  a  shine  on 
the  surface  of  the  paper  which  not  only  irritates  the  eyes 
but  blurs  the  vision.  This  is  one  of  the  worst  faults  in 
desk  lighting.  A  desk  lamp  should  never  be  placed  in 
the  middle  of  the  desk,  but  well  over  to  the  left  side,  or 
the  right  side  for  left-handed  people. 

In  reading  always  sit  with  the  back  towards  the 
light  or  table.  Writing  or  reading  with  the  book  on 
the  table  necessitates  bending  forward  the  head  and 
chest,  which  seriously  interferes  with  the  proper  action 
of  the  lungs  and  heart,  which  in  the  case  of  children 
may  result  in  permanent  deformity. 

It  is  a  common  mistake  to  suppose  that  the  brighter 
the  light  the  better  it  is  for  fine  eye-work.  The  amount, 
or  intensity,  of  illumination  must  be  varied  according 
to  the  color  of  the  objects  seen.  For  reading  or  wTiting 
on  white  paper,  or  sewing  on  white  goods,  a  compara- 
tively small  amount  of  light  is  required,  and  too  much 
light  may  produce  a  dazzling  effect  upon  the  surface. 
If,  on  the  other  hand,  work  is  done  on  dark  material, 
such  as  sewing  on  dark-colored  cloth,  from  three  to  five 
times  as  much  light  may  be  required. 

Bare  light  sources  in  the  line  of  vision  are  abso- 


for  the  Conservation  of  Vision  13 

liitely  bad  and  to  be  avoided,  whether  in  the  home, 
school,  public  hall,  factory  or  office.  They  dazzle  the 
eyes,  produce  eye-strain  and  prevent  clear  vision,  and 
are  therefore  both  harmful  and  uneconomical. 

Mirrors  and  polished  surfaces  should  be  avoided 
absolutely  in  nurseries  and  rooms  in  which  children  or 
others  habitually  use  their  eyes  for  close  work,  such  as 
writing,  reading  or  sewing,  unless  the  light  sources  are 
well  screened  from  them.  Light  reflected  from  a  pol- 
ished table  is  even  more  annoying  than  the  direct  light, 
since  it  comes  from  the  direction  in  which  the  eye  is 
unaccustomed  to  bright  lights.  The  familiar  snow- 
blindness  is  an  exaggerated  case  of  this  effect. 

Lamps  of  any  kind  should  not  be  too  near  the  eyes, 
since  all  light  sources  give  off  a  considerable  quantity 
of  heat  which  is  very  irritating.  Anyone  who  has 
looked  at  a  fire  in  a  grate  will  understand  the  discom- 
fort to  the  eyes  from  radiated  heat. 

Industrial  Lighting. 

The  use  of  bad  lighting  for  industrial  purposes  is 
an  outrage  on  those  who  work  under  it,  and  the  cause 
of  serious  losses  to  the  manufacturer  by  reducing  the 
quality  and  quantity  of  work  which  the  operative  turns 
out.  The  cost  of  good  artificial  light,  even  if  used  dur- 
ing the  entire  working  hours,  will  not  represent  more 
than  half  of  one  i^er  cent,  of  the  w^orkmen's  wages. 
The  question  of  cost  of  the  light  is  wholly  inconsiderable 
as  compared  with  the  efficiency  of  the  worlonen. 

This  especially  applies  to  offices  and  industries 
emploj'ing  female  labor,  for  the  double  reason  that  such 
labor  commonly  requires  much  careful  vision,  and  the 
female  constitution  is  most  susceptible  to  nervous 
strains  of  any  kind. 

Great  improvements  in  the  production  and  use  of 
artificial  light  have  been  made  within  the  past  ten  years, 
and  it  is  now  a  proven  fact  that  by  the  selection  of  the 


14  Bulletin  of  the  American  Association 

proper  light  sources  and  accessories,  and  their  correct 
placing  with  reference  to  those  using  the  light,  it  is  pos- 
sible to  produce  conditions  of  illumination  which  will 
enable  the  eyes  to  be  used  with  the  same  degree  of  effi- 
ciency and  comfort  as  by  natural  light. 

Where  illumination  is  to  be  furnished  to  a  consid- 
erable number  of  people,  as  in  schools,  offices,  factories, 
public  halls,  etc.,  the  services  of  a  competent  illuminat- 
ing engineer  should  be  secured.  The  directions  given 
for  the  lighting  of  the  home  can  generally  be  carried 
out  by  the  householder,  and  if  assistance  is  desired  the 
local  lighting  companies  can  now  be  depended  upon 
to  give  safe  and  sound  advice. 


for  the  Conservation  of  Vision  15 


Structural  Defects  of  the  Eye 

The  structure  of  an  eye,  from  the  optical  stand- 
point, maj^  be  conveniently  compared  to  a  camera,  in 
which  the  diaphragm  corresponds  in  the  eye  to  the  pupil 
in  the  middle  of  the  iris,  the  photographic  lens  to  the 
crystalline  lens,  the  dark  chamber  of  the  camera  to  the 
interior  chamber  of  the  eye,  and  the  sensitive  plate  of  the 
photographic  apparatus  to  the  sheet  of  nervous  tissue 
in  the  eye  called  the  retina,  on  which  the  rays  of  light 
fall  in  order  that  the  images  of  external  objects  may 
be  perceived.  Any  luminous  point  diffuses  light  in  all 
directions  in  straight  lines.  These  lines  are  called  the 
rays  of  light.  Rays  which  come  from  an  infinite  dis- 
tance are  parallel,  but  as  there  is  very  little  difference 
to  the  eyes  between  rays  coming  from  twenty  feet  and 
those  coming  from  infinity,  this  distance  of  twenty  feet 
(or  six  meters)  may  be  regarded  for  practical  purposes 
as  infinity.  Rays  which  come  from  any  point  nearer 
than  this  distance  are  divergent. 

The  formation  of  images  of  external  objects  on  the 
sheet  of  nervous  tissue  which  is  called  the  retina,  or,  in 
other  words,  the  function  of  seeing  correctly,  depends 
upon  what  is  called  the  refracting  apparatus  of  the  eye, 
which  consists  of  a  series  of  lenses,  the  most  important 
one  of  which  is  known  as  the  crystalline  lens,  and  which 
corresponds  to  the  photographic  lens  in  the  camera. 
Now  the  rays  of  light  which  have  been  described  must 
have  a  certain  character  in  order  to  be  brought  to  a 
focus  on  the  retina  of  the  eye,  which  corresponds  to  the 
sensitive  plate  of  the  camera.  If  the  eye  is  of  exactly 
the  proper  length  it  is,  without  any  exertion,  adapted  to 
receive  parallel  rays.  Such  an  eye  is  a  normal  eye,  tech- 
nically known  as  an  emmetropic  eye.  If  the  eye  is  too 
long,  that  is,  longer  than  the  normal  eye,  it  is  adapted 
only  to  receive  divergent  rays,  or  such  rays  as  come  from 


16  Bulletin  of  the  American  Association 

objects  nearer  than  infinity,  as  it  has  been  before  de- 
scribed. Such  an  eye  is  a  near-sighted  or  a  short-sighted 
eye,  technically  known  as  a  mj^opic  eye.  If  the  eye  is 
too  short,  that  is,  shorter  than  the  normal  eye,  it  is 
adapted  only  to  receive  convergent  rays,  or  such  rays 
as  have  been  passed  through  a  convex  lens  or  come  from 
a  concave  mirror,  because  in  nature  there  are  no  con- 
vergent rays,  but  only  divergent  and  parallel  rays. 
Such  an  eye  is  a  far-sighted  or  over-sighted  eye,  tech- 
nically known  as  a  hyperopic  eye. 

Naturally  this  relation  of  the  rays  of  light  to  the 
eye  must  be  constantly  changing  in  accordance  with  the 
position  of  the  object  looked  at,  that  is  to  say,  wliether 
the  object  is  far  from  or  near  to  the  eyes.  Therefore 
the  focus  of  the  eye  must  constantly  be  altered  to  meet 
these  conditions.  With  a  camera,  to  which  the  eye  has 
been  compared,  this  is  readily  accomplished  by  altering 
its  length,  but  this  cannot  be  done  with  an  eye  because 
the  eyeball  is  inextensible.  Therefore  this  can  only  be 
brought  about  in  an  eye  either  by  changing  the  adjust- 
ment of  its  lenses,  that  is,  by  increasing  their  power,  or 
by  placing  in  front  of  the  eye  lenses  of  different  values. 
This  adjustment  of  the  eyes  for  the  purpose  of  seeing 
objects  at  different  distances  is  accomplished  by  the  con- 
traction of  a  small  muscle  in  the  eye  which  increases  the 
power  of  the  crystalline  lens  of  the  eye,  and  the  power 
w^hich  is  thus  exercised  is  called  the  power  of  accommo- 
dation. 

These  explanations  are  made  in  order  that  the 
reader  may  understand  what  is  meant  by  eye-strain,  or 
those  difficulties  which  occur  when  the  structure  of  the 
eye  is  not  normal,  that  is  to  saj^  when  it  is  either  far- 
sighted  or  near-sighted.  If  the  normal  eye  wishes  to 
see  objects  at  a  distance,  it  can  do  so  without  effort 
because  it  is  adapted  to  receive  parallel  rays,  which,  as 
has  been  explained,  are  those  rays  which  proceed  from 
distant  objects,  and  only  when  objects  are  held  close  to 


for  the  Conservation  of  Vision  17 

the  ej^e — as,  for  example,  print — the  muscle  which  has 
been  described  exercises  its  contracting  power  in  order 
to  increase  the  value  of  the  crystalline  lens.  On  the 
other  hand,  if  an  eye  is  far-sighted,  it  could  not  see  ob- 
jects at  any  distance  distinctly  because  it  is  adapted  to 
receive  only  convergent  rays,  and  such  raj^s  do  not 
exist  in  nature,  the  raj^s  coming  from  distant  points 
being  parallel  and  those  from  near  points  divergent. 
Therefore  this  muscle  must  be  in  a  constant  state  of 
tension  in  order  to  give  the  rays  the  necessary  converg- 
ence, so  that  images  shall  be  correctly  focussed  upon  the 
back  of  the  eye  on  the  sheet  of  nervous  tissue  which  has 
been  compared  to  the  sensitive  plate  of  the  camera. 

This  constant  tension  produces  many  of  the  symp- 
toms of  eye-strain.  The  most  important  of  these  are 
headache,  which  may  occur  in  any  portion  of  the  head, 
pain  in  and  around  the  eyes,  congestions  and  irritations 
of  the  eyes,  and  a  host  of  nervous  sjTiiptoms  which  at 
one  time  were  not  at  all  understood,  that  is  to  say,  their 
cause  was  not  known;  for  example,  vertigo,  sleepless- 
ness, twitchings  so  severe  that  they  may  be  comparable 
to  convulsive  seizures,  night  terrors,  dyspepsia,  often 
called  nervous  dyspepsia,  melancholia,  hj^steria,  neuras- 
thenia, and  many  other  similar  phenomena.  These  phe- 
nomena may  be  so  aggravated  that  if  the  eye-strain  is 
not  stopped  by  the  adjustment  of  suitable  glasses  the 
health  of  the  patient  breaks  down,  and  his  capacity  for 
work  is  not  only  very  often  limited  but  sometimes 
entirely  checked. 

If,  on  the  other  hand,  the  eye  is  near-sighted,  that 
is  longer  than  the  normal  eye,  it  cannot  see  distant 
objects  with  anj^  distinctness,  but  only  such  objects  as 
are  near  enough  to  furnish  the  rays  which  are  suffi- 
ciently divergent  to  focus  the  image  of  the  object  prop- 
erly on  the  back  of  the  eye.  Therefore  these  patients 
are  constantly  straining  to  see  things  which  are  far  away, 
and  often  the  strain  is  very  severe,  as  they  are  much  in 


18  Bulletin  of  the  American  Association 

the  condition  of  one  who  tries  to  see  the  details  of  a 
blurred  photograph,  or  one  which  has  been  improperly 
focussed. 

But  more  important  than  either  far-sightedness  or 
near-sightedness  is  the  presence  of  what  is  known  as 
astigmatism.  In  the  presence  of  astigmatism,  which 
depends  upon  the  fact  that  the  clear  membrane  in  front 
of  the  eye,  called  the  cornea,  has  a  greater  refracting 
power,  for  example,  in  the  vertical  meridian  than  it  has 
in  the  horizontal,  so  that  the  eye  can  never  focus  accu- 
rately a  point  of  light,  but  can  only  see  a  point  drawn 
out  as  a  circle,  an  oval  or  a  line,  the  effort  of  sight,  or 
eye-strain,  is  enormously  increased. 

What  astigmatism  means  can  best  be  understood, 
perhaps,  by  remembering  that  the  word  is  derived  from 
two  Greek  words  which  mean  practically  the  inability 
to  see  a  point  of  light  as  a  point  of  light.  Under  these 
circumstances  the  effort  either  of  the  near-sighted  or 
of  the  far-sighted  eye  (because  astigmatism  may  occur 
either  in  near-sighted  or  in  far-sighted  eyes)  is  greatly 
increased  and  the  images  it  receives  are  always  blurred 
and  distorted.  That  is  the  reason  why,  when  astig- 
matic eyes  look  at  a  series  of  parallel  lines,  some  of  the 
lines  are  seen  clear  and  black,  while  others  are  blurred 
and  fuzzy,  and  such  eyes  readily  mistake  letters  which 
are  similar  to  one  another,  s's  and  v's,  m's  and  w's,  t's 
and  3'^'s,  etc.,  and  because  of  these  things  there  is  an  ever 
increasing  effort  and  constant  elaboration  of  eye-strain 
in  its  most  pronounced  form.  The  influence  of  astig- 
matism, if  uncorrected  or  inaccurately  treated,  pro- 
duces the  worst  type  of  eye-strain  and  the  symptoms 
which  have  been  described  as  characteristic  of  it  in  the 
most  violent  degree.  It  would  take  many  pages  to 
describe  the  evils  which  uncorrected  astigmatism  has 
produced. 

Now  all  of  these  conditions,  far-sightedness,  near- 
sightedness and  astigmatism,  can  be  perfectly  relieved 


for  the  Conservation  of  Vision  19 

by  suitably  adjusted  glasses.  The  difficulty  is  that 
because  the  eyes  themselves  look  normal,  and  often 
because  there  is  no  pain  in  the  eyes,  the  symptoms  are 
not  believed  to  be  the  result  of  eye-strain  and  treatment 
is  not  properly  directed.  Therefore  it  is  absolutely 
necessary  for  the  health  of  children  that  before  they  go 
to  school  their  eyes  should  be  carefully  examined  by  a 
competent  physician  to  find  whether  or  not  they  are  in 
a  normal,  or  practically  normal,  condition,  and  if  the 
far-sightedness  is  greater  than  the  eye  can  bear,  and 
if  there  is  any  astigmatism,  these  errors  of  focus  should 
be  corrected  so  that  the  child  may  begin  the  studies 
of  early  life  without  these  handicaps.  More  than  this, 
inasmuch  as  near-sightedness  develops  because  of  many 
conditions  which  are  undetected  in  early  life,  amongst 
the  most  important  of  which  are  errors  of  focus,  the 
early  investigation  of  eyes  will  prevent  in  many  cases 
the  development  of  near-sightedness  and  prevent  the 
serious  consequences  to  which  reference  has  been  made, 
and  which  in  general  terms  are  known  as  the  results  of 
eye-strain.  Fortunately  in  properly  conducted  schools 
at  the  present  time  these  examinations  are  made  at  suit- 
able intervals,  but  it  should  be  the  object  of  every  one 
who  is  interested  in  education  and  in  the  bringing  up  of 
children  to  make  it  a  point  that  no  child  is  allowed  to 
begin  his  school  career  until  a  satisfactory  examination 
of  the  eyes  has  been  made.  There  is  no  excuse  that  the 
expense  of  treatment  may  act  as  a  deterrent  to  such 
examinations,  because  if  children  are  poor  all  such 
measurements  and  investigations  can  always  be  made 
in  hospitals  and  dispensaries  where  competent  physi- 
cians are  at  work  and  where  the  treatment  is  free. 
Therefore  the  poor  are  in  no  sense  excluded  from  the 
benefits  of  such  examination. 


20  Bulletin  of  the  American  Association 


Accidents 

Impaired  vision  and  blindness  itself  are  only  too 
frequently  the  results  of  accidents.  !Many  of  these  acci- 
dents are  due,  on  the  one  hand,  to  carelessness  on  the 
part  of  workmen,  and,  on  the  other,  to  indifference  in 
the  erection  or  use  of  suitable  safety  devices. 

Eyes  are  constantly  exposed  to  danger  in  many 
occupations  and  industries.  Among  them  maj'-  be  men- 
tioned grinding,  stone-trimming,  sand-blasting,  turn- 
ing metal  at  a  speed  sufficient  to  cause  flying  chips, 
working  with  a  cold  chisel,  forging,  and  rolling  steel. 
Again,  there  are  occasional  risks  to  the  eyes  in  other 
occupations,  a  notable  instance  of  which  is  the  danger 
of  bursting  to  which  the  glass  water  gauges  on  boilers 
are  always  subject. 

The  safeguards  are  comparatively  simple.  The 
best  type  of  emer^'^  wheels  now  have  guards  to  protect 
the  eyes  of  the  workman  from  the  flying  particles  and 
blowers  to  draw  in  the  dust  and  discharge  it  elsewhere. 
Some  lathes  have  glass  or  wire-netting  screens  to  guard 
the  eyes  of  the  operator  from  flj^ing  turnings.  In  cases 
where  there  is  danger  of  sharp  particles  rebounding  and 
reaching  the  eye,  canvas  screens  are  arranged,  so  that 
the  fragments  striking  them  either  stick  in  the  texture 
or  fall  dead.  In  forging  special  forms  of  goggles  may 
be  provided,  and  in  some  of  the  steel  rolling  mills  the 
platforms  on  which  the  operators  of  the  rolls  are  sta- 
tioned are  guarded  by  a  sheet  of  plate  glass,  thus  effect- 
ually protecting  the  eyes  of  the  workers  from  injury. 

A  safe  device  which  has  found  very  general  accept- 
ance is  a  series  of  rods  down  the  sides  of  the  water  gauge 
tubes  on  boilers.  In  the  event  of  the  tube  bursting 
these  rods  prevent  the  glass  from  flying  in  all  directions. 

Farmers  working  in  the  fields  are  often  injured 
by  being  struck  in  the  eyes  with  a  beard  of  wheat. 


for  the  Conservation  of  Vision  21 

Such  a  seemingly  trifling  injun^  may  be  the  cause  of  a 
serious  ulcer  of  the  cornea  which  will  destroy  the  eye, 
and  should  such  an  accident  occur,  the  workman  should 
at  once  stop  his  labor  and  no  time  should  be  lost  in 
placing  the  eye  under  proper  treatment. 

Bits  of  mortar,  lime,  and  particles  of  molten  lead 
produce  most  serious  injuries  of  the  ej'^e.  If  lime  or 
mortar  is  the  offending  substance  the  ejx  should  imme- 
diately be  flushed  with  a  stream  of  cold  water  and  all 
foreign  particles  removed.  As  quickly  as  possible  the 
patient  should  seek  competent  medical  advice  and 
receive  treatment.  Very  disastrous  are  the  conse- 
quences of  the  bursting  of  the  receptacles  containing 
anmionia,  so  much  used  at  present  in  refrigerating 
plants,  and  every  precaution  should  be  taken  by  work- 
men and  by  employers  to  guard  against  the  dangers  of 
ammonia  burns  under  these  circumstances. 

Every  one  is  familiar  with  the  protruding  hatpin 
which  on  more  than  one  occasion  has  been  responsible 
for  the  loss  of  an  eye.  Public  sentiment  has  been  some- 
what aroused  and  some  legislation  has  been  enacted; 
but  it  is  high  time  that  this  silly  freak  of  fashion  should 
be  abolished. 

Fourth  of  July  celebrated  in  the  conventional 
manner  has  been  a  persistent  menace  to  eyesight,  and 
every  j^ear  many  eyes  are  destroyed  by  the  senseless 
and  reckless  discharge  of  fireworks  and  firecrackers. 
The  recent  movement  for  a  "safe  and  sane  Fourth"  is 
one  which  all  who  believe  in  conserving  vision  will 
heartily  endorse. 

The  commonest  accident  to  the  eye,  however,  is 
what  is  known  as  "getting  something  in  the  eye."  The 
"something"  may  be  a  grain  of  dust,  a  cinder,  a  piece 
of  ash,  a  bit  of  iron  or  steel,  etc.  If  the  foreign  body 
gets  beneath  the  upper  lid,  the  eye,  exposed  to  a  good 
light,  should  be  examined  in  the  following  manner: 
Ask  the  patient  to  look  down,  then  take  hold  of  the 


22  Bulletin  of  the  American  Association 

eyelashes  with  the  thumb  and  forefinger  of  the  left 
hand,  pull  the  eyelid  downward  and  slightly  away  from 
the  eyeball,  and  evert  it  by  placing  midway  between 
the  eyelashes  and  eyebrow  the  tip  of  the  thumb  of  the 
right  hand  and  gently  making  the  same  movement 
which  would  be  required  to  turn  back  the  edge  of  a  cuff 
or  sleeve.  During  all  these  maneuvers  the  patient 
must  steadily  look  downward.  If  the  particle  rests  on 
the  under  surface  of  the  lid,  it  can  now  be  seen  and  can 
be  removed  with  the  corner  of  a  clean  handkerchief,  or 
better,  with  a  fragment  of  pure  cotton  twisted  on  the 
end  of  a  matchstick.  The  handkerchief  should  not 
be  twisted  to  a  point  with  soiled  fingers,  and  should 
never  be  moistened  with  the  tongue.  If  the  body  is  not 
found  on  the  under  surface  of  the  upper  lid,  it  should 
be  searched  for  beneath  the  lower  lid  and  removed  in 
the  same  way.  If  the  body  is  imbedded  in  the  cornea, 
it  is  usually  necessary  to  have  skilled  advice,  and  the 
body  is  removed  after  the  eye  has  been  made  insensitive 
with  cocain.  In  many  workshops  and  on  trains  the 
laborers  and  trainmen  have  a  habit  of  removing  these 
bodies  with  toothpicks  which  have  been  moistened  with 
saliva.  This  is  a  most  pernicious  practice,  as  the  saliva 
often  contains  an  active  germ,  which  if  inoculated  into 
the  eye  produces  a  violent  ulceration.  Many  eyes  have 
been  lost  in  this  manner. 

A  filthy  practice  among  ignorant  persons  is  to 
attempt  to  remove  the  body  with  the  tip  of  the  tongue, 
often  followed  by  disastrous  consequences.  A  silly 
performance  is  to  introduce  beneath  the  eyelids  a  so- 
called  "eye-stone"  or  a  flaxseed,  in  the  belief  that  it 
will  remove  the  foreign  substance.  Eyes  inflamed  as 
the  consequence  of  injury  or  disease  are  often  treated 
with  applications  of  tea-leaves,  poultices,  scraped  pota- 
toes, and  the  like.  Such  meddlesome  domestic  medica- 
tion has  in  many  instances  been  followed  by  serious 
results. 


for  the  Conservation  of  Vision  23 

Contagion  maj"  be  carried  into  the  eye  by  the  for- 
eign body,  and  after  its  removal  the  eye  should  be  pro- 
tected and  frequently  irrigated  with  a  saturated  solu- 
tion of  boric  acid. 

Ordinary  "black  eye"  is  caused  by  the  rupture  of 
bloodvessels.  Home  treatment  in  simple  cases  con- 
sists of  cold  ap]3lications  for  one  hour  and  then  hot 
applications  until  the  congestion  about  the  eye  is  ab- 
sorbed. 

In  any  cases  where  the  results  seem  at  all  serious 
a  physician  should  be  called  in. 


24  Bulletin  of  the  American  Association 


Diseases  of  the  Eye 

The  eyelids  are  lined  and  the  eyeball  is  covered 
with  a  membrane  which  is  called  conjunctiva.  This 
is  a  mucous  membrane  similar  to  the  membrane,  for 
example,  which  lines  the  mouth.  It  is  very  readily 
infected  by  various  poisons,  notably  those  which  are 
produced  by  bacteria.  Under  these  circumstances  vio- 
lent inflammation  arises,  which  is  called  conjunctivitis. 
There  are  many  varieties,  but  the  most  important  are: 

Gonorrhoeal  Ophthalmia.  This  is  a  most  violent 
form  of  inflammation  which  occurs  if  the  virus  of  gonor- 
rhoea is  transferred  to  the  eye,  either  because  the  person 
himself  is  affected  with  this  disease  and  some  of  the 
matter  gets  into  the  eyes,  or  very  frequently  because 
the  eyes  have  been  touched  with  something  that  has 
been  contaminated  with  the  gonorrhoeal  poison,  the 
sufferer  himself  being  innocent  of  the  disease.  Tliis 
happens,  for  example,  when  soiled  linen  is  used;  if  the 
face,  for  instance,  has  been  wiped  with  a  towel  in  the 
toilet  room  of  a  railway  station,  this  towel  having  pre- 
viously been  used  by  somebody  who  was  thus  affected. 
Unless  the  disease  is  very  promptly  treated  it  rapidly 
destroys  the  sight,  producing  great  ulcers  of  the  eye 
which  perforate  its  coats  and  speedily  produce  blind- 
ness. The  greatest  care,  therefore,  should  be  exercised 
by  those  who  travel  and  who  are  obliged  to  use  the 
public  toilet  rooms,  bath  rooms,  wash  stands,  etc.,  and 
such  towels  should  never  be  used  in  drying  the  face,  or 
used  in  any  way  so  that  they  may  come  in  contact  with 
the  eyes,  for  fear  that  some  uncleanly  and  affected  per- 
son has  contaminated  them. 

Ophthalmia  Neonatorum.  This  is  a  disease,  often 
called  "babies'  sore  eyes,"  which  usually  appears  about 
the  third  day  after  birth,  and  in  its  worst  varieties  it  is 
caused  by  the  same  virus  which  originates  gonorrhoeal 


for  the  Conservation  of  Vision  25 

ophthalmia,  because  during  the  birth  of  the  child  the 
eyes  come  in  contact  with  infecting  secretions.  This 
disease  is  the  cause  of  much  blindness,  and  at  the  pres- 
ent time  there  are  probably  more  than  10,000  children 
in  the  United  States  that  have  lost  their  sight  through 
its  results.  jNIoreover,  it  is  pathetic  to  remember  that 
most,  if  not  all,  of  these  children's  eyes  could  have  been 
saved  had  the  proper  remedies  been  used  when  the 
children  were  born,  because  it  has  been  known  for  many 
years  that  what  is  called  Crede's  method  is  an  almost 
sure  safeguard,  even  though  the  child  should  be  born 
of  a  mother  who  is  afflicted  with  this  disease.  It  should 
be  a  punishable  offense  for  any  one  in  attendance  on  a 
woman  in  labor  who  fails  promptly  to  report  the  appear- 
ance of  any  purulent  material  in  the  eye  of  a  baby  soon 
after  its  birth,  because  if  the  disease  is  promptly  treated 
by  those  who  are  familiar  with  the  proper  remedies 
the  eyes  can  be  saved;  and  more  than  this,  it  should  be 
required  of  those  who  are  in  attendance  on  labor  cases 
where  it  has  been  impossible  to  determine  before  the 
birth  of  the  child  whether  the  mother  is  free  from  infec- 
tion or  not,  that  the  remedy  to  which  reference  has 
been  made  should  be  used.  This  remedy  consists  in 
a  1  per  cent,  solution  of  nitrate  of  silver,  one  drop  of 
which  is  put  into  each  eye  as  soon  as  the  baby  is  born, 
the  eyes  afterwards  being  covered  with  cold  compresses 
to  subdue  the  slight  irritation  which  the  remedy  causes. 
Of  course  it  is  not  necessary  to  use  this  prophylactic 
in  the  better  class  of  practice,  where  the  physician  can 
make  himself  sure  of  conditions  before  the  birth  of  the 
child,  but  it  should  alwaj^s  be  used  where  such  assurance 
cannot  be  obtained,  or  where  it  is  known  that  the  mother 
is  infected. 

Trachoma.  This  disease  is  often  called  granular 
lids,  and  is  an  affection  of  very  ancient  origin.  It  is 
endemic  in  certain  regions  of  the  world,  for  example, 
in  Egypt,  and  is  one  of  the  greatest  menaces  with  which 


26  Bulletin  of  the  American  Association 

the  iimnigration  officers  have  to  contend,  as  the  poor 
immigrants,  especially  from  certain  regions,  for  exam- 
ple, Italy,  Eastern  Prussia,  Russia,  etc.,  are  often, 
owing  to  lack  of  proper  inspection  at  the  various  points 
of  exit,  affected  with  this  disease.  Under  its  influence 
granulations  grow  in  the  eyelids  and,  by  rubbing  over 
the  front  of  the  eyeball,  produce  ulcers  which  are  likely 
to  mar  the  sight  and  sometimes  destroy  it.  In  certain 
regions  of  our  own  countrj"  it  is  also  an  endemic  disease, 
and  one  case  introduced  into  a  region  where  the  laws 
of  hygiene  are  not  properly  carried  out  and  where  poor 
people  are  huddled  together  in  small  rooms,  tenement 
houses,  etc.,  may  cause  a  widespread  infection  through- 
out the  inmates  of  such  region  or  of  such  houses.  For- 
tunately the  rules  of  inspection  of  immigrants  are  strict, 
but  even  so,  a  certain  number  of  patients  with  trachoma 
get  into  our  country,  and,  moreover,  mild  types  of  the 
affection,  which  may  at  any  time  take  on  a  severe  char- 
acter, are  unfortunately  present  among  the  school  chil- 
dren of  some  of  our  large  cities.  Wherever  many  chil- 
dren, or,  for  that  matter,  grown-up  people,  are  gath- 
ered together  under  the  conditions  which  have  been 
described,  a  frequent  inspection  of  the  eyelids  is  there- 
fore necessary,  and  the  detection  of  any  one  affected 
with  this  disease  should  be  followed  by  his  immediate 
isolation  in  order  that  the  spread  of  the  disease  may  be 
checked. 

Phlyctenular  Keratitis.  This  is  a  disease  of  the 
eye,  known  by  the  name  just  recorded,  which  attacks 
children  usually  in  the  poorer  walks  of  life  who  are  of 
a  strumous  habit.  Now  we  know  that  this  really  means 
that  they  have  a  form  of  tuberculosis,  and  it  is  probable 
that  this  disease  should  be  regarded  as  one  of  the  mani- 
festations of  the  so-called  tubercular  diathesis.  When 
it  occurs  little  blister-like  bodies  form  on  the  lining  of 
the  eyeball  and  on  the  clear  membrane  in  front  of  the 
ej^eball,  which  is  known  as  the  cornea,  and  these  break 


for  the  Conservation  of  Vision  27 

down  and  create  ulcers,  in  their  turn  followed  by  scars 
which  materially  affect  the  vision.  Careful  treatment, 
not  only  of  the  eyes  themselves,  but  of  the  constitution, 
in  order  to  neutralize  the  effect  of  constitutional  causes 
of  this  disease,  are  followed  by  the  happiest  results,  but 
it  is  very  important  that  the  mothers  of  children  should 
realize  how  serious  the  later  effects  of  this  disease  are, 
and  that  these  children  should  promptly  receive  compe- 
tent examination  and  treatment. 

Acute  Conjunctivitis.  There  are  a  great  many 
varieties  of  inflammation  of  the  conjunctiva  caused  by 
bacteria  which  are  not  so  seriously  poisonous  as  those 
which  bring  into  existence  gonorrhoeal  ophthalmia  and 
ophthalmia  neonatorum.  One  of  the  most  notable  of 
these  affections  is  the  one  commonly  known  as  "pink 
eye,"  which  is  prevalent  especially  in  the  spring  months. 
It  is  exceedingly  contagious  and  will  sometimes  attack 
many  children  in  a  school,  or  many  adults  who  are  living 
in  the  environments  of  the  affection.  While  it  is  not 
apt  to  produce  blindness  and  can  readily  be  cured  by 
mild  measures,  neglected,  it  often  leaves  the  eye  weak- 
ened and  irritable  and  subject  to  other  inflammatory 
states  owing  to  the  congestion  of  the  membrane  which 
remains  after  the  severity  of  the  disease  has  subsided. 

Cataract.  Cataract  is  a  term  which  means  that 
the  crystalline  lens  of  the  eye  becomes  opaque.  Some- 
times children  are  born  with  cataract;  sometimes  from 
various  causes  young  persons  acquire  cataract;  but  the 
commonest  form  is  the  cataract  of  old  persons,  and 
therefore  called  senile  cataract,  and  which  comes  about 
as  part  of  the  degenerative  changes  which  take  place  in 
many  tissues  of  the  bodj^  as  age  advances.  It  is  certain 
that  the  best  hygiene  of  the  eye — ^that  is  to  say,  taking 
care  that  the  eyes  are  always  used  with  suitable  light  and 
not  subjected  to  prolonged  strain,  and  that  if  their 
focus  is  imperfect  it  be  corrected  with  glasses — pre- 
vents the  development  of  cataract,  although  if  patients 


28  Bulletin  of  the  American  Association 

live  long  enough  some  form  of  cataract  is  apt  to  appear. 
If  the  cataract  becomes  complete,  that  is  to  say,  gets 
ripe,  it  can  readily  be  removed  by  an  operation,  which 
is  in  the  largest  nmnber  of  instances  successful.  Fool- 
ish advertisements  often  appear  with  the  statement  that 
there  are  certain  remedies,  absorbing  remedies,  which 
can  cure  cataract.  This  is  not  true.  Proper  treatment 
of  the  eyes  and  of  the  patient  doubtless  may  render 
the  development  of  cataract  less  rapid,  but  when  a 
cataract  is  formed,  and  when  it  is  fully  formed,  there 
is  only  one  way  to  relieve  the  patient  and  that  is  by 
operation.  Some  occupations  render  patients  liable  to 
cataract,  for  example,  glass-blowers  and  those  who  live 
and  M^ork  in  very  heated  rooms,  for  example,  puddlers, 
and  therefore  great  care  should  be  exercised  by  these 
workers  to  protect  the  eyes  as  much  as  possible  from 
the  blinding  glare  of  the  light  under  which  they  must 
labor. 

Glaucoma.  There  is  a  very  serious  disease  of  the 
eyes  which  is  called  glaucoma,  and  which  comes  about 
because  what  is  known  as  the  eye  tension  becomes  in- 
creased. Exactly  why  this  occurs  is  not  fully  under- 
stood, although  the  treatment  of  the  disease,  when  it 
occurs,  especially  in  the  so-called  acute  varieties  of  it, 
is  quite  successful.  These  acute  varieties  are  associ- 
ated with  great  pain  and  redness  of  the  eye,  which 
becomes  very  hard,  and  blindness  speedily  ensues  unless 
the  eye  is  promptly  treated.  It  is  uncommon  in  young 
persons,  but  elderly  persons  who  have  any  violent  pain 
in  and  around  the  eye,  especially  if  it  is  associated  with 
loss  of  vision,  should  speedily  seek  relief  and  not  allow 
precious  time  to  be  wasted  with  the  thought  that  they 
are  suffering  with  a  neuralgia  of  the  eye  which  will  pass 
away.  There  are  also  some  chronic  varieties  of  the 
disease  in  which  there  is  little  or  no  pain,  but  a  slow 
loss  of  vision  owing  to  a  gradual  degeneration  of  the 
optic  nerve,  and  very  often  patients  believe,  because 


for  the  Conservation  of  Vision  29 

they  are  old  and  their  vision  is  failing,  that  they  are 
probably  getting  cataract  and  that  they  must  wait  until 
it  gets  ripe  before  anj^thing  can  be  done.  This  is  the 
greatest  folly.  Any  person  past  middle  life  who  has 
any  feeling  that  his  sight  is  failing  should  always  go  at 
once  and  have  it  investigated.  It  may  be  due  to  some 
simple  trouble,  error  of  focus  or  the  like,  which  is  readily 
relieved,  but  it  may  also  be  due  to  the  beginning  of  this 
disease,  and  it  is  only  when  one  sees  the  disease  in  its 
earlier  stages  that  the  proper  remedies,  either  medical 
or  surgical,  can  be  applied  to  check  its  progress.  A 
verj^  curious  symptom  of  this  disease,  which  sometimes 
is  manifested  for  long  periods  of  time,  is  the  appearance 
of  colored  rings  around  lights;  for  example,  if  the  eye 
looks  at  an  electric  light,  it  seems  to  be  surrounded 
with  a  sort  of  rainbow.  If  any  one  ever  has  a  symptom 
like  this,  not  a  minute's  delaj'-  should  occur  until  he  goes 
to  a  competent  phj^sician  for  investigation. 


30  Bulletin  of  the  American  Association 


The  Conservation  of  Vision 

To  promote  all  the  methods  by  which  eyesight  may 
be  protected  and  conserved  there  has  been  formed  the 
American  Association  for  the  Conservation  of  Vision. 
Its  object  directly  appeals  to  every  individual,  for  no 
one  is  exempt  from  impairment  of  sight  by  accident, 
disease,  or  by  the  improper  use  of  the  eyes. 

In  order  to  accomplish  its  purpose  most  effectively 
the  work  of  the  Association  has  been  divided  into  six 
different  departments  as  follows: — 

Department  of  Diseases  and  Defects  of  the  Eye; 
Educational  Department    (hygiene   of  the   eyes   in 

schools)  ; 
Industrial  Department  (hygiene  of  the  eyes  in  fac- 
tories, stores  and  offices) ; 
Department  of  Statistics  and  Information; 
Department  of  Legislation; 
Department  of  Publicity. 

Each  of  these  departments  is  conducted  bj^  a  Direc- 
tor, with  a  staff  of  five  or  more  associates,  and  such 
special  committees  as  may  be  found  useful,  the  work  of  > 
all  departments  being  coordinated  by  the  general  super- 
vision of  the  Board  of  Managers  and  the  constant  assist- 
ance of  the  General  Secretary. 

The  activities  of  the  Association  will  be  directed : 

First :  to  collecting  and  coordinating  existing  infor- 
mation on  the  various  matters  pertaining  to  the  con- 
servation of  vision. 

Second:  to  a  careful  and  impartial  investigation  of 
matters  upon  which  present  knowledge  is  either  incom- 
plete or  inconclusive. 

Third:  to  standardizing  methods  and  practices  as 
fast  as  definite  knowledge  can  be  obtained. 

Fourth :  to  carrying  on  a  general  campaign  of  edu- 
cation in  regard  to  the  proper  care  and  use  of  the  eyes. 


for  the  Conservation  of  Vision  31 

Fifth:  to  securing  legislation  tending  to  prevent 
wilful  or  ignorant  practices  which  result  in  injury  to  or 
destruction  of  vision. 

To  insure  an  impartial  review  of  conditions  and 
sound  conclusions  from  existing  knowledge  of  the  vari- 
ous subjects,  and  unbiased  investigations,  the  personnel 
of  the  Departments  and  Committees  of  the  Association 
will  be  confined  rigidly  to  the  profession  and  to  laymen 
who  have  no  commercial  interests,  directly  or  indirectly, 
in  the  objects  of  the  Association.  Every  necessary  pre- 
caution will  be  taken  to  obtain  the  most  accurate  and 
authoritative  scientific  facts. 

The  work  of  educating  the  public  will  be  done 
through  the  frequent  issuance  of  bulletins  on  special 
subjects,  by  lectures,  by  exhibitions,  by  cooperation  with 
other  scientific  and  humanitarian  organizations,  and 
publicly  through  the  newspaper  and  periodical  press. 

The  American  Association  for  the  Conservation  of 
Vision  is  the  outgrowth  of  a  movement  having  its  origin 
in  a  desire  to  prevent  blindness  from  infectious  disease, 
and  which  gradually  developed  and  extended  its  pur- 
pose until  it  included  the  prevention  of  all  causes  of 
impaired  vision. 

The  following  organizations  and  committees  were 
identified  with  this  initial  movement  and  will  be  actively 
affiliated  with  this  Association  in  its  work :  Committee 
on  Prevention  of  Blindness  of  the  Russell  Sage  Foun- 
dation; Committee  on  Prevention  of  Blindness  of  the 
New  York  Association  for  the  Blind ;  Maryland  Society 
for  the  Prevention  of  Blindness;  Ohio  State  Commis- 
sion for  the  Blind;  Massachusetts  Commission  for  the 
Blind;  Kentucky  Society  for  the  Prevention  of  Blind- 
ness ;  Arkansas  Association  for  the  Prevention  of  Blind- 
ness ;  Missouri  Association  for  the  Prevention  of  Blind- 
ness; California  Association  for  the  Prevention  of 
Blindness;  Committee  on  Prevention  of  Blindness  of 
the  American  Medical  Association ;  Committee  on  Con- 


32  Bulletin  of  the  American  Association 

servation  of  Vision  of  the  National  Educational  Asso- 
ciation; Jlliiminating  Engineering  Society;  and  Com- 
mittee for  the  Blind  of  the  Council  of  Jewish  Women. 

Membership  in  the  Association  is  open  to  all  who 
are  interested  in  any  way  in  any  of  its  objects.  Mem- 
bers are  sought  rather  as  a  channel  through  which  to 
promote  the  objects  of  the  Association  than  as  a  source 
of  contributions,  financial  or  otherwise.  The  member- 
ship fee  is  $1.00  a  j^ear. 

The  constitution  provides  that  all  those  who  apply 
for  membership  during  the  first  year  and  pay  an  initia- 
tion fee  of  $5.00  shall  be  enrolled  as  charter  members. 
It  is  believed  that  the  objects  of  the  Association  are 
such  that  many  will  wish  to  contribute  this  small  addi- 
tional amount  to  its  foundation.  The  annual  dues  for 
charter  members  will  be  the  same  as  those  of  the  regu- 
lar members,  namely,  $1.00  a  year. 

Both  classes  of  members  will  receive  the  general 
bulletins  of  the  Association. 

The  ultimate  value  of  the  work  of  the  Association 
will  depend  primarily  upon  the  funds  available  for  its 
use.  Those  desiring  to  further  the  work  for  scientific 
or  humanitarian  reasons  are  invited  to  make  further 
contributions.  If  desired,  such  contributions  may  be 
made  for  specific  purposes. 

There  is  pressing  need  of  immediate  work  by  all 
departments  of  the  Association.  Will  you  further  this 
work  by  becoming  a  member  and  thus  lending  your 
support? 

The  American  Association  roR  the  Conservation 

OF  Vision 
25  West  39th  Street,  New  York  City. 


for  the  Conservation  of  Vision  33 


OFFICERS: 

President,  Dk.  F.  Paek  Lewis,  Buffalo; 

Vice-President,   E.   Leavenworth   Elliott,   New 
York; 

Secretary,  Ida  B.  Hiltz^  New  York; 

Treasurer,  Samuel  Ely  Eliot,  New  York. 

BOARD  OF  MANAGERS: 

E.  Lea^t:x WORTH  Elliott,  New  York, 

Editor  of  The  Illuminating  Engineer. 

T.   COMMERFORD  MaRTIN,  NcW  Yoi'k, 

Secretary     National     Electric     Light     Association; 
Formerly  editor  of  The  Electrical  World. 

James  P.  Muxroe,  Boston,  Mass., 

President  of  the  Massachusetts  Commission  for  the 
Blind;  Chairman  of  "Boston  1915." 

H.  FiTz-JoHN  Porter,  New  York, 
Efficiency  Engineer. 

F.  S.  ToMLiN,  New  York, 

Secretary  of  the  Federated  Committees  on  Workmen's 
Compensation  of  the  New  York  Labor  Unions. 

J.  A.  Shawan,  Columbus,  Ohio, 

Superintendent  of  Schools;  member  of  the  Council  of 
the  National  Educational  Association. 

Edward  M.  Van  Cleve,  Columbus,  Ohio, 

President   of   the   Ohio   Commission  for   the  Blind; 
Superintendent  Ohio  State  School  for  the  Blind. 

M.  C.  Whittaker,  New  York, 

Professor  of  Industrial  Chemistry,  Columbia  Univer- 
sity. 

Dr.  Hiram  Woods,  Baltimore,  Md., 

Vice-President  Maryland  Society  for  the  Prevention 
of  Blindness, 


UNIVERSITY  OF  CALIFORNIA  LIBRARY 

Los  Angeles 
This  book  is  DUE  on  the  last  date  stamped  below. 


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